  <p>
    <b>Domestic violence</b><br />
    <%= f.check_box :domestic_violence %>
  </p>

  <p>
    <b>City</b><br />
    <%= f.text_field :city %>
  </p>

  <p>
    <b>Number of children</b><br />
    <%= f.text_field :number_of_children %>
  </p>

  <p>
    <b>Turned away</b><br />
    <%= f.check_box :turned_away %>
  </p>

  <p>
    <b>Referrals given</b><br />
    <%= f.check_box :referrals_given %>
  </p>

  <p>
    <b>Hotline number</b><br />
    <%= f.text_field :hotline_number %>
  </p>

  <p>
    <b>Caller name</b><br />
    <%= f.text_field :caller_name %>
  </p>

  <p>
    <b>Victim name</b><br />
    <%= f.text_field :victim_name %>
  </p>

  <p>
    <b>Volunteer name</b><br />
    <%= f.text_field :volunteer_name %>
  </p>

  <p>
    <b>Call time</b><br />
    <%= f.datetime_select :call_time %>
  </p>

  <p>
    <b>Caller age</b><br />
    <%= f.text_field :caller_age %>
  </p>

  <p>
    <b>Caller ethnicity</b><br />
    <%= svs_checkboxes :hotline_call, :caller_ethnicity, ["test", "foo"] %>
    <%= f.text_field :caller_ethnicity %>
  </p>

  <p>
    <b>Abuse type</b><br />
    <%= f.text_field :abuse_type %>
  </p>

  <p>
    <b>Abuser relationship</b><br />
    <%= f.text_field :abuser_relationship %>
  </p>

  <p>
    <b>Call language</b><br />
    <%= f.text_field :call_language %>
  </p>

  <p>
    <b>Child abuse</b><br />
    <%= f.check_box :child_abuse %>
  </p>

  <p>
    <b>Abuse description</b><br />
    <%= f.text_area :abuse_description %>
  </p>

  <p>
    <b>Child abuse last incident</b><br />
    <%= f.date_select :child_abuse_last_incident %>
  </p>

  <p>
    <b>Dv last incident</b><br />
    <%= f.date_select :dv_last_incident %>
  </p>

  <p>
    <b>Last shelter</b><br />
    <%= f.text_field :last_shelter %>
  </p>

  <p>
    <b>Last shelter date</b><br />
    <%= f.date_select :last_shelter_date %>
  </p>

  <p>
    <b>Asked to leave shelter</b><br />
    <%= f.check_box :asked_to_leave_shelter %>
  </p>

  <p>
    <b>Police notification place</b><br />
    <%= f.text_field :police_notification_place %>
  </p>

  <p>
    <b>Police notification date</b><br />
    <%= f.date_select :police_notification_date %>
  </p>

  <p>
    <b>Po in place</b><br />
    <%= f.check_box :po_in_place %>
  </p>

  <p>
    <b>Valid until</b><br />
    <%= f.date_select :valid_until %>
  </p>

  <p>
    <b>Weapon type</b><br />
    <%= f.text_field :weapon_type %>
  </p>

  <p>
    <b>Caller financial status</b><br />
    <%= f.text_field :caller_financial_status %>
  </p>

  <p>
    <b>Has transportation</b><br />
    <%= f.check_box :has_transportation %>
  </p>

  <p>
    <b>Medications</b><br />
    <%= f.text_field :medications %>
  </p>

  <p>
    <b>Injuries</b><br />
    <%= f.text_field :injuries %>
  </p>

  <p>
    <b>Special accommodations</b><br />
    <%= f.text_area :special_accommodations %>
  </p>

  <p>
    <b>Entered</b><br />
    <%= f.check_box :entered %>
  </p>

  <p>
    <%= submit_tag "Update" %>
  </p>

